Provider Demographics
NPI:1194323436
Name:RUDICK, ALISON LEE (LMSW)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:LEE
Last Name:RUDICK
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:L
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3084 KLUG ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3223
Mailing Address - Country:US
Mailing Address - Phone:616-889-6607
Mailing Address - Fax:
Practice Address - Street 1:1556 LOUMILEN DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-1584
Practice Address - Country:US
Practice Address - Phone:616-889-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011081841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801118519OtherLICENSE